medwireNews: Treatment with biologics in combination with conventional DMARDs is associated with a reduction in the duration of protective immunity induced by the 17DD yellow fever (YF) vaccine among patients with rheumatoid arthritis (RA), research suggests.
Conversely, conventional DMARDs given alone did not appear to influence the longevity of vaccine response, report Clarissa de Castro Ferreira, from the Universitário de Brasília in Brazil, and co-investigators.
The study included 121 individuals with RA who were undergoing treatment with conventional DMARDs alone or in combination with biologics and had received a single dose of the 17DD-YF vaccine more than 1 year prior to study entry.
Ferreira and colleagues demonstrated that neutralizing antibody responses – measured by a plaque-reduction neutralization test (PRNT) – diminished more quickly among the 48 patients treated with biologics in combination with conventional DMARDs than in the 73 patients taking only conventional DMARDs and 226 healthy controls.
Specifically, at 5–9 years after vaccination, the PRNT seropositivity rate was 76% in biologic-treated patients compared with 89% for those taking conventional DMARDs alone and 83% for healthy controls. Seropositivity rates had declined to a comparable degree in all three groups at 10 years after vaccination, however, at 76%, 72%, and 71%, respectively.
The team also identified a decrease in markers of cellular memory, including EMCD4, interleukin (IL)-5CD4, CMCD8, and EMCD8, as early as 5–9 years postvaccination among patients in the biologic group compared with those given only conventional DMARDs and healthy controls.
“In association with the PRNT, EMCD8 and IL-5CD4 were recently nominated as the most relevant biomarkers to follow up with the immune response over time after the 17DD-YF vaccination,” explain the researchers in Arthritis Research & Therapy.
Ferreira et al say that “[t]hese findings could support changing the vaccination schedule” for biologic-treated RA patients, “with the possibility of a planned booster dose upon the suspension of [biologic] DMARD in cases where this is allowed, even 10 years following 17DD-YF vaccination.”
And they conclude: “The benefit of a planned booster dose should be evaluated in further studies.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group
Arthritis Res Ther 2019; 21: 75
See also: